The challenges of breastfeeding Part 1

Breastfeeding can be one of your most precious times with your baby or babies. However, challenges can make the road to nirvana difficult.

When you dreamed about how life would be after your baby is born, you likely imagined a picture like this one below with a happy baby and beaming and comfortable Mom.

But instead, what you got was:

Typical initial difficulties with breastfeeding include sore nipples, sleepy baby, excessive weight loss in the first two weeks, and engorgement. Later problems include thrush, plugged ducts, and mastitis. We will focus on the initial problems with this post.

Sore nipples

In the first few days, you may notice some soreness that is caused by stretching of your nipples. This is usually at a pain level of a 3 or less during and after the feeding. The soreness can be worse at the beginning of the feeding by subsides within a minute or so. It starts to improve after the first 3-5 days.

If your nipples are painful;

a pain level of greater than a 3 for the entire feeding or between feedings is usually

from a bad latch. A good latch can help prevent any damage to your nipples.

Other reasons for pain:

-The shape of your baby's mouth

-A tight frenulum (otherwise known as tongue-tie &/or lip-tie).

An easy way to tell if there is a problem or if your body just needs to become adjusted to the stretching of your nipples is to look at your nipples after feeding. If they are a funny shape after nursing, then it is likely that your baby is having trouble with latching or keeping a deep latch.

It could be that your baby is just not opening his mouth wide enough, which is very common in the beginning.

Babies are born as tummy feeders and when they come to breast on their tummy, nose to nipple, they will begin to open their mouth more and more widely. They extend their tongue, which then pushes out the lower lip. Let him be responsible for opening his mouth and he will learn that he can't latch unless he opens widely enough.

An easy way to make sure he doesn't slip to the end of your nipple and keeps your nipple in deeply enough is to lean back when nursing. When you do this, gravity takes care of keeping him in place. If he feels himself slipping, he will bite to keep the nipple in his mouth.

This is another way that the nipple becomes a funny shape (and not ha-ha). Otherwise, make sure you have a couple of pillows under him or a boppy with a pillow under it. Don't worry that you will always need these devices and techniques. Once he is a few weeks old, you will find other ways to keep him in the right position if you don't have a pillow handy.

Baby losing too much weight-

Babies normally lose weight after birth, sometimes up to about 8-10% of their body weight after birth. As normal jaundice (known as physiologic) sets in, the baby gets sleepier and then doesn't nurse as effectively.

Ways to help your baby nurse better:

1) Keep your baby at the breast only as long as baby is "actively nursing", in other words,

is having frequent sucking and swallowing. As soon as your baby is done being active, remove

him from the breast and switch to the other side

2) Gently squeezing your breast while your baby is nursing will increase the flow of milk and help

him drink more milk

3) After nursing both sides, hand express or pump and give the baby the milk by your desired

method

After a day or two, your baby may start waking up for feedings and staying more active at the breast. **The best way to make sure that baby is getting enough milk when nursing is a weight gain, about 20-30 grams per day (¾-1 oz per day). A feeding assessment with test weighing will show you how much the baby is taking at each feeding. We can help with this!

Engorgement -

When your milk comes in, you will start to also develop swelling. This can also extend into your armpits and feel like a lump. If your milk isn't removed often enough, the swelling becomes worse and the breasts can become hard, called engorgement. Although a good, long nap sounds really good after going home, this could set you up for engorgement.

If you are just noting tightness and fullness, continue to nurse frequently and it will improve in a couple of days. However, if your breasts are very uncomfortable &/or hard, this not only makes it hard for baby to latch, but can make it difficult for the milk to be removed. At any time that your baby isn't removing enough milk to make you comfortable, hand express or pump until your breasts are comfortable.

After the feeding (and hand expressing/pumping until comfort):

-Place cold packs on your breasts or chilled, cabbage leaves. To prepare the leaves,

rinse off the leaves and place in a plastic bag and keep in the fridge

-Remove enough to totally cover your breasts and into armpits if you have swelling

there

- Lie down for an hour or so and your breasts should be much more comfortable after

To make it easier for your baby to latch or before pumping, try doing "Reverse Pressure Softening".

If your breasts are continuing to be too difficult for baby to latch, lie down and apply oil, like coconut or olive oil, to your fingers. Gently glide over your breasts, ending at the armpit for about 1-2 minutes on each side. You are trying to move the excess lymph fluid so the milk can be more easily removed. This is called therapeutic breast massage and was developed by Maya Bolman IBCLC. The following link shows how to do this:

Baby Sleepy -

Babies usually nurse well and active for about the first 1-2 hours after birth, then become sleepy for the next 8-12 hours.

Even though you can try to feed your baby the recommended 8 or more in 24 hours, he may not be able to wake up enough to do a good job. Hand express every time you try to nurse and then give this to your baby by finger feeding, a spoon or dropper. This can make sure he is eating enough. The more he eats, the more he will poop and the lower his jaundice levels will be. Usually, this leads to nursing better, pooping more, losing less weight, and lower jaundice levels.

As with most breastfeeding concerns, it can be helpful to speak with a Lactation Consultant. Our Wellspring Lactation consultants are here to help, offering virtual and in-home consults to address any of your questions and concerns.